Health Leadership P11

This is what the government’s asking patients. I can’t get her to lie. I can’t, whenever she leaves the hospital, slip her a hundred dollar bill and say, “Lie.” You know, I can’t do that. I can’t say “Make this stuff up.” Now, why are they doing that? Do you have any idea why they would do this? Do you have any idea where healthcare’s going in the United States right now? It’s going to quality, too. It’s going to quality, and if you aren’t producing a quality product, your reimbursement’s going to go down, down, down, down, down, down, down. So we were in the top ten percent the first year that HCAPS came out in the whole United States. In the entire United States. This is what happened right after Rod left. We were here. We were there when you left, right? Wasn’t that the year that was – yeah. We were projected at a million dollar loss, and that’s where we – it actually was 2.3 million, they adjusted it after I left. And this was some really interesting accounting that I’m not going to get into again, it was system related, but the reality was it was profit in an area where Mercy and [inaudible] should both still be, but they’re gone and Windber is still there.

Think about that. When I got there, there was six million dollars, about six million in the bank, six million dollars that was flexible. Not really flexible. And I convinced the board to allow me to build a new building, and that new building ended up costing ten million dollars, but once we started the building and people saw the vision behind the building, we got a federal grant and we got a state grant and we got a local grant and we got a community grant, and we got – and so we ended up with – and we got a million dollars in donations through a hospice, so the ten million dollar building became a reality by borrowing basically against the last six million dollars that we had. And when you think about going through that at a time when there was some serious activities going on at the federal government at this level, because basically, if you think about what happened when Clinton was the president and Mrs. Clinton tried to get healthcare reform passed, once the hospitals did not back that, we became public enemy number two, right behind the Mafia.

And hospitals function, they have something called a charge master – this this? I don’t know how thick they are, Rod, they’re pretty darn thick, right? So everything’s in there, like what it costs for a Q-tip, what it costs for an aspirin, what it costs – and if you inadvertently, if someone in the food chain marks one of those wrong so it says a Q-tip is forty-one dollars instead of twelve cents or whatever, and you inadvertently charged for that Q-tip every single time somebody used a Q-tip, that was a federal offense. That was a federal offense, and my peers, some of them went to prison. It was a crazy, tough time. This is something that never could have figured would happen. And this went on, by the way. It’s like down here now.

So it just kept going down. What does that mean? Well, typically, you’re paid on diagnostic related groups, which means that if you have your gallbladder out, you’re going to get X number of dollars, and you’re going to get X number of dollars based on your geography, so if you’re in downtown New York City, Manhattan, or if you’re in Windber, the same operation’s going to cost differently and you’re going to be reimbursed differently, but it’s going to be the same for everybody that’s supposedly in your geographic type arena.

And let’s say hypothetically that you should be in the hospital on a regular gallbladder surgery for three or four days. You’re going to get paid the same amount of money whether they’re in for three or four days or three or four hours. Generally, unless it’s outpatient [inaudible]. This is way too much detail for you, but the bottom line on this thing is that the sooner the people left, and weren’t readmitted and weren’t still sick and didn’t have to come back, what did that mean for you?

You use less resources. You made more money. So this ended up being a very important aspect of what’s going on. The average length of stay dropped. This is something that nobody ever in the whole world could have predicted. Hospitals infect you, nationally, at the rate of nine percent. I had a friend who went in for a surgery two weeks ago, [inaudible] knee surgery, came home, died. I had two friends went into a very prominent, major heart hospital, had two incredibly difficult surgeries, came home, both died. Now, the ones that died from those surgeries didn’t die from the surgery. What did they die from? The infection. They died from the infections.

And hospitals breed infections. They morph. They grow. It’s kind of like they just happen. One of the reasons not too many people are fighting tearing down [inaudible] is because they have all kinds of real exotic infections now from all the different world wars and all the fighting from all the places. So the average hospital infection rate is nine percent. That means you have almost a ten percent chance of going into the hospital perfectly healthy, getting a simple little surgery, and getting a staph infection that might or might not kill you. That’s unacceptable from my perspective.

I mean, I had three heart [inaudible], and there’s only a one percent chance they would screw up on a heart [inaudible]. They screwed up three times on me. So even one percent when it’s you, you know, major surgeries, anything that happens to me. Our infection rate dropped to below one percent. And again, if I extended this, it stayed below one percent. National average nine percent, ours was one percent. Now, some people would say, “Well, you must have washed your hands more often.” I don’t thinks so. Some people would say, “Well, you were a little, crappy hospital and nobody sick really came there.” Nah. Sick people came there just like they came to all the hospitals around here from the same nursing homes with the same infections.

So we had high morbidity, high mortality, high infections, but our infection rate never went about one percent, and the joint commissioner [inaudible] say, “It’s impossible. It’s impossible.” And we’d say, “Nope, that’s what’s going on.” And department of health would come and say, “You can’t have a one percent. It’s got to be nine percent or eight percent, or some hospitals that you know of are at twenty-four percent, twenty-seven percent.” They didn’t publish these numbers, but they’re going to. You’re going to be able to call and say, “What’s your infection rate before I have my surgery? Can you tell me what your infection rate is in that area?” Ours dropped to below one percent, and it stayed below one percent.

Why do you think it did that? I’ll tell you why I think it did it. I had Penn State and Georgia Tech come study us. They couldn’t figure it out. Let me ask you something. Have any of you ever been admitted to a hospital for anything other than like nothing? Any of you ever go into a hospital? So, hospitals are scary places. And if you think about the typical environment of the hospital, you have overhead paging going on, you have codes going on, you know, if someone died in the room next to you. You have people coming in and out, looking at you, shaking their head, writing things, putting it away. It’s not a comfortable place to be. You can’t sleep well. You don’t like what it smells like usually. So take that environment and flip it upside down.

We had the plug in things that put out good aromas, and we had you laying in bed and a massage therapist says, “Would you like to have your feet massaged, would you like to have your neck massaged?” And the harp player or the guitar player comes in and says, “What’s your favorite song?” They start to play for you. Your loved one, you want her to stay here? Yeah, absolutely, she can stay here, that’s fine. Here’s a bed for her. She can sleep here. Now all of a sudden instead of being in an environment where you’re waiting for the saber tooth tiger to jump on your face and eat you, you’re with someone that you care about, hopefully, and cares about you. Hopefully. If you want them. If you don’t want them, they don’t have to stay there.

And we stopped the overhead paging, and we stopped the middle of the night wake you up for no reason. Think about that. I think that the infection rate dropped to one percent because your white blood cells actually get a chance to work. You get to fight off infection because you’re not living there going, “I’m going to die. There’s a tiger on my throat.” Right? Is it possible? Philosophically it’s possible. This is the one I wanted to do the billboard on. Mortality comparison by hospital. This is assuming the same co-morbid conditions. These are all of our peer hospitals, and that would be Windber. And the billboard would have read, “Come to Windber. You’ll die less often.”

I don’t know if any of these things are anywhere there now, but I’m talking this was a picture in time, and it’s not a pro-Windber advertisement. Like I said, I’m detoxed, do whatever you want to do, but I’m pointing out to you that there are some amazing things that came out of this that I couldn’t have predicted, which is why we made 2.3 million dollars. I mean, if your length of stay goes down and your restraint rate goes down and your readmission rate goes down because they aren’t coming back sick, and you don’t have to bring people back in to treat them for the infections that you gave them for which the government will no longer pay you starting about a year or so ago, I guess. So you start to look at all these things, and it’s like wow, if you’re nice to people and you’re nice to employees and you do things a little differently but they’re not so far out, I mean, I didn’t bring in like witch doctors from the street corners to shake crystals over people.

I mean, we were very careful. We had credentialing process, and we did all the things that you have to do to be acceptable, but if you do that and you wow people and you treat them with dignity, you don’t have to leave your dignity at the door. We gave them pajama bottoms for gosh sakes. Your butt didn’t have to stick out. Dignity. Used to give them bath robes, but they stole them all. So what are the limitations? The limitations are what you self-impose. It was really funny.